"Impossible" reversed radial forearm free flap in microsurgical reconstruction

The reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed.